Increasing use of cannabis edibles in response to recreational cannabis legalization in the United States.

Abstract

To evaluate the associations between recreational cannabis legalization in the United States and primary mode of cannabis use (smoking, eating/drinking, vaporizing/dabbing) overall and across groups. We linked data on 69,109 adults reporting past month cannabis use from 37 states in the 2017-2023 Behavioral Risk Factor Surveillance System with recreational cannabis legalization and retail sales. Using multinomial logit regression models, we examined the associations between legalization and primary mode of cannabis use overall and by demographic and higher-risk strata, with demographic and policy controls and state and year fixed effects. Among cannabis users, smoking declined but remained the most prevalent mode of cannabis use in 2023 (62.7%), followed by eating/drinking (21.5%), and vaporizing/dabbing (15.8%). Compared to smoking and vaping/dabbing cannabis, the likelihood of eating/drinking cannabis increased by 35% (adjusted relative risk ratio 1.35; 95% CI 1.20, 1.52) and 33% (1.33; 1.14, 1.55), respectively, post-legalization. Similar patterns emerged in response to retail sales. There was evidence of larger increases in eating/drinking cannabis among males than females post-legalization, and among middle-aged and older adults than younger adults after retail store openings. Recreational cannabis legalization and retail sales led to more frequent use of cannabis in edible and drinkable forms.